Do not “take two aspirins and call me in the morning”: The story of Polio-Like AFM

On August 4, 2020 the CDC warned doctors and parents to be on the lookout for a polio-like illness called acute flaccid myelitis, or AFM. This scary illness has recently peaked every two years, and the CDC anticipates that 2020 may be a bad year. Alert doctors right away for any sudden limb weakness, especially between August and November. All the more so if there has been any recent fever, respiratory illness, or neck or back pain.

To put this in perspective, AFM is real, but rare. In the worst “bad” year there were 238 cases in the US, out of about 74 million kids: less impact than car crashes each year. And I expect that this year may be less, because of the social distancing and hand washing we are already practicing. It’s flu season in the southern hemisphere, but this year cases of flu are greatly decreased.

But while AFM is rare, and I’d worry less about it than car crashes, it is important to know about, in order to get a child care and support as soon as it is suspected, rather than waiting until tomorrow.

I have a couple of suggestions, below, of what to do at the first signs of respiratory infection this year. But first, some background I wrote in 2014:

The story began on August 19, 2014 when a children’s hospital in Kansas City notified the CDC that almost two-dozen children had been admitted to the hospital with a severe respiratory illness. Four days later the CDC heard from a different children’s hospital 511 miles away, reporting more than a dozen seriously ill children hospitalized in Chicago with the same symptoms.

The CDC quickly tested specimens from these children and detected an unusual culprit that causes AFM: enterovirus D68. There are more than a hundred different enteroviruses, divided into four groups (type C is polio). Most enteroviruses cause only minor illnesses. They are responsible for 10 million or more common colds in the summer and fall every year.

Enterovirus EV-D68 wasn’t discovered until 1962 and has only been found in a few people in several small outbreaks around the world since then. Until now.

What do we know from the first confirmed cases of AFM in 2014?

All of the AFM cases were in children. They ranged in age from 6 weeks to 16 years with an average age of 4 or 5 years.

All of them got sick enough that they ended up in the pediatric intensive care unit, with a number of them on mechanical ventilators – often within only 24 hours of first developing cold symptoms.

All of them had difficulty breathing. Some described it has feeling like they were drowning. Or just couldn’t breathe.

Most of them (70%) already had a respiratory problem, such as asthma.

Nevertheless, only a few of them (about 1 in 5) wheezed during this illness. For most it was difficulty breathing, but no wheezing was detected.

And only a few of them (about 1 in 5) had a fever.

What can we do? 

Previous testing by the CDC and other labs has confirmed that Enterovirus EV-D68, unlike 100+ other enteroviruses, is vulnerable in a laboratory setting to acidity (pH 3) and to warmth (temperature at or above 98.6 degrees F).

This hasn’t been tested as a remedy in people, but since the virus doesn’t grow well in these conditions, and since it can proliferate in the back of the throat, it makes sense to me to make conditions inhospitable several times a day to perhaps prevent or even help eradicate the virus.

For acidity you might try a squeeze of lemon or a spray of apple cider vinegar, which both have a pH of 3 or less. For a child who is old enough, you might even try gargling with it. An apple or some blueberries – many fruits – can have a pH close to 3 and may help.

For warmth, I’m a fan of soups and warm liquids. And if the child does get a fever, it might be the body trying to destroy the virus. It’s wise to talk with a doctor before rushing to try to bring it down.

When to get help

If children with cold symptoms seem to take a turn for the worse – especially if they already have asthma – it’s time to call or see a doctor. This applies to any child with difficulty breathing. AFM can move quickly, so waiting until morning is not wise.

For kids with asthma, using a peak flow meter can be a great way to monitor how well they are breathing even before you notice difficulty.

The AFM story continues

Probably many children and adults have had the infection and have not been sick enough to test. Probably most with the virus have minor, if any, symptoms.

Within four weeks of August 19, 2014 the outbreak of very sick children had spread to 27 different states.

Peaks have since occurred every two years, with the largest (238 cases in 42 states) in 2018.

Cleaning hands and frequently touched surfaces, covering (and staying at a distance from) sneezes and coughs, and avoiding shared utensils helps reduce the spread of AFM.

Spreading the word helps kids get care in time.